Healthcare Provider Details

I. General information

NPI: 1801947288
Provider Name (Legal Business Name): JEFFREY R STRAWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STETSON AVENUE
CINCINNATI OH
45219
US

IV. Provider business mailing address

3200 BURNET AVENUE CENTRAL CREDENTIALING
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7700
  • Fax: 513-558-0877
Mailing address:
  • Phone: 513-558-7700
  • Fax: 513-558-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.089201
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41393
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: